Patient details :-

• Patient name – XYZ
• Age – 59 yrs
• Sex – female
• Occupation – house wife
• Problem Since 12 Yrs

Chief complains :-

• Pain in both knee joints
• Mild pain in both ankle joints
• Swelling and stiffness in both knee joints
• Feeling numbness (wooden leg feeling) in right lower limb while sleeping
• Pain in low back radiating to lower limbs on & off

History of present illness :-

• Patient is a known case of GRIDHRASI treated with physiotherapy and traction few yrs back.
• Occasionally feels the symptoms of back ache radiating to lower limbs.
• Patient approached Ayurvedic department for the complaints of swelling and pain in knees, painful and restricted movements of knee joint.
• The complaints were seen since 12 yrs and slowly increasing in nature.
• Presently patient finds difficulty in walking and attending routine activities due to varus deformity.
• She often used to take pain killers which gave only temporary relief.
• She is also c/o feeling of heaviness and pain in her thigh more in the right thigh.
• Patient is unable to turn position in her sleep at night and when both knees touch each other feels severe pain due to which notices sleep disturbance.
• Patient feels slight reduction of pain at rest and aggravation after her activities and late evening hours.
• Patient had approached orthopedician before visiting our department and was advised knee replacement therapy for which patient approached our dept. for a alternative treatment approach.
• All her complaints were seen after attaining her menopause.

Past history:-

Patient had an infected abscess in the left thigh for which she was operated around 12 yrs back.   ( Details of which are not available.)

ALLERGY:-

No h/o allergy present.

TREATMENT HISTORY:-

Patient is a known case of hypothyroidism since 5 yrs and on Tab. ELTROXIN 100mcg 1-0-0

MENSTRUAL HISTORY:-

Attained menopause about 12 yrs back

OBSTETRIC HISTORY:-

• Menarche – at 15 yrs
• Menopause – at 46 yrs
• Two children ( 1-♀& 1-♂)
• Both deliveries were normal.

FAMILY HISTORY:-

Her mother and sisters are suffering from Sandhivata.

Personal history :-

• Diet  – mixed
• Appetite – good
• Bowel – regular
• Micturition – regular
• Sleep – disturbed
• Habits – Nil

General examinations :-

• Built – average
• Nutrition – good
• Gait – waddling gait
• Pallor , Icterus , Clubbing – absent
• Lymphadenopathy – absent
• Temperature – afebrile
• Pulse rate – 76/min , regular
• Blood pressure – 140/80 mmHg
• Weight – 72.3 kg
• Tongue – moderately coated

Systemic examination :-

• Respiratory system – No added sound heard.

• Cardiovascular system –S1 S2 heard.

• GIT  – NAD

• CNS – No sensory and motor deficit.

• Loco motor system:-

1. Inspection –Structural deformity – bow leg deformity seen.
2. Palpation –tenderness on both thighs , more in right thigh & particularly medial aspect of thigh.
3. Knee joint examination :-
   

   	Right	Left
   Inspection
   Swelling	++	+
   Redness	–	–
   Palpation
   Tenderness	++( inferiomedial & inferiolateral aspect )	+ (inferiomedial aspect)
   Crepitus	++	++
   Local rise in temperature	–	–
   Movements	Restricted (flexion)	Restricted (flexion)

4. Ankle joint examination :-
   

   	Right	Left
   Inspection
   Swelling	+	+
   Redness	–	–
   Palpation
   Tenderness	–	–
   Local rise in temperature	–	–
   Movements	Slight painful (dorsiflexion & extension )	Slight painful (dorsiflexion & extension )

5. Spine examination –Inspection – no abnormal curvature seen.Palpation – no local rise in temperature.no tenderness
   SLR test – (+) in right leg ( around 60 %)(-) in left leg

Ayurvedic assessment :-

1. Prakratitah –

• Prakathi – vata pittaja
• Saara – madhyama
• Samhana – madhyama
• Pramanataha – height -5’3”

weight – 72.3 kg

(BMI – 29)

• Saatmya – madhyama
• Satva – madhyama
• Aahaara sakhti – madhyama
• Vyayama shakti – madhyama to avara
• Vaya – madhyama
• Desha – anoopa

2. Vikratitah –

• Naadi – vata pitaaja
• Mootra – not examined
• Mala – not examined
• Jiwha – alpa uplepa yukta
• Shabda – prakrit
• Sparsha –prakrit
• Druk – prakrit
• Aakriti –madhyama
• Dosha –vata kaphaja
• Doosya – rasa, mamsa , asthi
• Agni – sama
• Kostha –madhyama

Investigation –

IIIrd grade OA

Differential diagnosis :-

• Sandhivata
• Aamavata
• Krostuka sheersha
• Vatarakta

TREATMENT Administered –

• Jeerak choorna ½ tsp-0- ½ tsp with 50 ml water for 3 days.
• Nadi sveda – 27/04/12 to 28/04/12 – no internal medicine was given during this procedure.
• Eranda tail upanaha sveda 30/04/12 to 15/05/12 – no internal medicine was given
• Tab. Ayuginee  1-0-1 for 4 months.
• Yastimadhu shaadita ksheerabasti 24/09/12 to 01/10/12 – no internal medicine was given

Effect of treatment :-

Right knee

Left knee

• Around 60% relief.
• Patient is feeling very much better.
• Knee joint is much relaxed.
• Able to flex her knee.
• Able to walk without much limping.
• Feeling of wooden leg is no more there, according to patient now she can feel her leg.

Kellgren – lawrence grading system for OA-